[2]Numerous small-scale efforts to change practices often improve the health of clients in one clinical setting or community, but their effects frequently decrease over time. The way these change efforts are introduced may cause their results to fade in the months after a project ends. How they are designed and implemented may hinder their expansion to additional clinical settings or communities. As a result, the gap between what is known and what is actually done about public health problems remains disappointingly wide.

Converting learning into practice can, however, yield permanent results. Experience in many countries shows that health managers can bring about lasting, meaningful change by becoming internal change agents within their work units, facilities, and organizations. By finding promising practices from other places that address their challenges, adapting them to their organization’s or community’s culture, and applying the practices, they can make long-term improvements in services and health. Successful health managers can extend the practices to additional settings and finally hand off the scale-up of such practices to others at the next organizational level who have appropriate contacts and authority.

This issue of The Manager focuses mainly on leading changes in practices that improve health, rather than on overall strategic and structural change. The issue can help health managers work with a team as change agents to address community and organizational challenges that require a change in clinical or management practices. It spells out key success factors for change and presents the five phases of a change process. It offers ways to work with people’s responses to change and provides a change agent’s guide to action to carry out a successful change effort.